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Long-term follow-up of different refractory systemic vasculitides treated with rituximab
Clinical Rheumatology, 05/03/2011
Clinical Article
Rees F et al. – The results of this study provide further evidence that RTX is an effective induction agent in systemic vasculitis. The optimal and long-term outcome of re-treatment remains to be defined.
Methods- Retrospective study
- 15 cases of refractory systemic vasculitis (11 Wegener's granulomatosis, 1 Churg–Strauss syndrome, 1 cutaneous polyarteritis nodosa and 2 cryoglobulinaemic vasculitis) treated with RTX, with mean follow-up of 34 months
- All had previously received CYC, and 14, at least 1 other immunosuppressive drug
- All had active disease when treated (median Birmingham Vasculitis Activity Score (BVAS) 2003, 13)
- All cases achieved remission (BVAS 2003, 0)
- 13 required re-treatment, 9 due to relapse (mean, 9 months after initial treatment) and 4 because of repopulation or rising ANCA in context of CYC intolerance or previous CYC refractory disease
- Relapsing cases have been successfully re-treated up to 5 further cycles, either at B cell repopulation or at 6 monthly intervals
- Infections rare
- Mean IgG levels fell significantly, and IgM levels became subnormal in 6 cases
- 3 cases of neutropenia, 1 severe at 10 months post-treatment
